Cryptococcosis is a disease caused by Cryptococcus neoformans, that most commonly affects immunosuppressed patients. Cutaneous cyptococcosis occurs in 10-15% of disseminated cases and its clinical manifestation is variable. We have presented an unusual manifestation of cutaneous cryptococcosis in a patient with iatrogenic Cushing syndrome. Clinically, the ulcers were considered to be pyoderma gangrenosum but the tissue biopsy and culture revealed cryptococcosis. This case illustrates that in making the diagnosis of pyoderma gangrenosum, one must exclude deep fungal infection.
Biopsy ; Cryptococcosis* ; Cryptococcus neoformans ; Cushing Syndrome ; Diagnosis ; Humans ; Pyoderma Gangrenosum* ; Pyoderma* ; Ulcer

Paecilomyces lilacinus is an ubiquitous saprophytic fungus and very rarely pathogenic to the human. Although it has been reported to cause endophthalmitis, orbital cellulitis, prosthetic valve endocarditis, and pulmonary infection, cutaneous infection caused by Paecilomyces lilacinus has been rarely reported. A 46-year-old Korean man had asymptomatic slowly growing multiple cutaneous nodules on the left arm and wrist for 8 months. He received a renal transplantation in 1991 because of end-stage renal disease. Postoperatively, he has taken cyclosporin and deflazacort for immunosuppression. Physical examination revealed that the lesions were discrete or confluent, firm, elevated, well-defined fluctuating nodules. Histologic section showed multiple well-encapsulated intradermal abscesses with some foci of chronic granulomatous changes composed of lymphocytes, histiocytes and giant cells. PAS positive fungal hyphae and spores were also found. On the Sabouraud's dextrose agar media, the organism grew rapidly to form velvety lilac-colored colonies with shallow radiating furrows. Slide culture showed brush-like conidiophores ending in flask-shaped phialides carrying chain of conidia. Because of the poor response to the oral antifungal drug for 2 months, all the lesions were completely excised.
Abscess* ; Agar ; Arm ; Cyclosporine ; Endocarditis ; Endophthalmitis ; Fungi ; Giant Cells ; Glucose ; Histiocytes ; Humans ; Hyphae ; Immunosuppression ; Kidney Failure, Chronic ; Kidney Transplantation ; Lymphocytes ; Middle Aged ; Orbital Cellulitis ; Paecilomyces* ; Physical Examination ; Spores ; Spores, Fungal ; Wrist

Distraction osteogenesis (DO) is a surgical method of bone formation that involves an osteotomy and sequential stretching of the healing callus by gradual movement and subsequent remodeling. DO is used to correct facial asymmetry, such as in patients with hemifacial microsomia, maxillary or mandibular retrusion, cleft lip and palate, alveolar defects, and craniofacial deficiency. It is accomplished with the aid of a distraction device, which is secured with screws placed directly into bone, for a predetermined length of time. Hemifacial microsomia is characterized by unilateral facial hypoplasia, often with unilateral shortening of the mandible and subsequent malocclusion. Patients with hemifacial microsomia and facial asymmetry have a vertically short maxilla, tilted occlusal plane, and short mandible. Early treatment is necessary to avoid subsequent impaired midfacial growth. The standard treatment of these malformations consists of the application of bone grafts, which can lead to unpredictable growth. The new bone-lengthening procedure represents a limited surgical intervention and opens up a new perspective for treatment, especially in younger children with severe deformities. This report describes a case of hemifacial microsomia (Type-II left-sided hemifacial microsomia). The patient, a 10-year-old child, visited our clinic for facial asymmetry correction. He had a hypoplastic mandible, displaced ear lobe, 10 mm canting on the right side, and malocclusion. We planned DO to lengthen the left mandible in conjunction with a Le Fort I osteotomy for decanting and then perform a right intraoral vertical ramus osteotomy (IVRO). Progressive distraction at a rate of 0.5 mm/12 hours was initiated 7 days postoperatively. The duration of DO was 17 days. The consolidation period was 3 months. Satisfactory results were obtained in our case, indicating that DO can be used successfully for functional, aesthetic reconstruction of the mandible. We report a case involving DO in conjunction with orthognathic surgery for correcting mandibular hypoplasia with a review of the literature.
Bony Callus ; Child ; Cleft Lip ; Congenital Abnormalities ; Dental Occlusion ; Ear ; Facial Asymmetry ; Goldenhar Syndrome* ; Humans ; Malocclusion ; Mandible ; Maxilla ; Orthognathic Surgery ; Osteogenesis ; Osteogenesis, Distraction* ; Osteotomy ; Palate ; Retrognathia ; Transplants

PURPOSE: The purpose of this study was to evaluate the usefulness of 99mTc DMSA scintigraphy on the dignosis of a renal scar in children with urinary tract infections. MATERIALS AND METHODS: Eighty three patients were included in this study, who were diagnosed as the urinary tract infection on the basis of symptom, urinalysis and urine culture. 99mTc DMSA scintigraphy and voiding cystoureterography were performed within 7days before the treatment in all patients. We classified the scintigraphic findings as follows: 1; a large hypoactive upper or lower pole. 2; a small hypoactive area. 3; single defect resulting in localized deformity of the outlines. 4; deformed outlines in a small or normal sized kidney. 5; multiple defects. 6; diffuse hypoactive kidney without regional impairment. Follow-up scintigraphy was done at least 6 months after the initial study. When the abnormality on the initial scintigraphy was not completely resolved on the follow-up scan, the lesion was defined as containing a scar. RESULTS: One hundred and fifteen renal units of 166 units (69.3%) showed abnormal findings on the DMSA scintigraphy. 65 units (56.5%) was diagnosed as containing renal scars on follow-up scintigraphies. Incidences of renal scar among renal units showing pattern 3, 4 and 5 on the initial scan was 75%, 78% and 78%, respectively. Whereas many of renal units showing 1, 2 and 6 pattern were recovered (65%, 76%, 50%). Sensitivity, specificity and accuracy of pattern-based DMSA scintigraphic findings on the diagnosis of renal scar was 76.9%, 85.1% and 81.9%, respectively. VUR was significantly associated with the renal scar when the initial DMSA shows unrecoverable findings (pattern 3, 4, 5). Odds ratio of the renal scar in a kidney showing unrecoverable initial scintigraphic findings was 19.1. Odds ratio in a kidney with mild or moderate-to-severe VUR was 3.5 and 14.4 respectively. CONCLUSION: In the urinary tract infection, renal scar was significantly developed in a kidney showing unrecoverable findings on the initial DMSA scan and VUR on voiding cystoureterography.
Child* ; Cicatrix* ; Congenital Abnormalities ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Kidney ; Odds Ratio ; Radionuclide Imaging ; Sensitivity and Specificity ; Succimer ; Technetium Tc 99m Dimercaptosuccinic Acid ; Urinalysis ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

Animals ; Bicuspid ; Calcium Phosphates ; Dogs ; Humans ; Light ; Mandible ; Microscopy ; Osteogenesis ; Young Adult

Adult ; Animals ; Bacteria ; Bicuspid ; Corrosion ; Dental Implants ; Dogs ; Hardness ; Humans ; Osseointegration ; Osteogenesis ; Osteogenesis, Distraction ; Titanium

Collagenous colitis is recognized as one of the causes of chronic diarrhea accompanied with autoimmune diseases. It is a disease associated with chronic watery diarrhea and typical histologic findings of a thick subepithelial collagenous deposit on biopsy. We experienced a 75-year-old man patient with chronic watery diarrhea and mild abdominal pain for 7 years. Physical examination, laboratory and radiologic studies were unremarkable except hypokalemia. Colonoscopy disclosed mucosal atrophy, loss of submucosal vessel and altered vascularity of terminal ileum, ascending colon. Colonoscopic biopsy revealed homogenous hyaline layered collagen deposition beneath the surface epithelium and Masson's trichrome stain showed collagen deposition. We report the case of collagenous colitis with a review of literature.
Abdominal Pain ; Aged ; Atrophy ; Autoimmune Diseases ; Biopsy ; Colitis, Collagenous* ; Collagen* ; Colon, Ascending ; Colonoscopy ; Diarrhea* ; Epithelium ; Humans ; Hyalin ; Hypokalemia* ; Ileum ; Physical Examination

This study was performed using mealtime atmosphere to characterize the food ecology of Korean children residing in different regions of Korea. A total of 705 elementary school students, 347 girls and 358 boys, were divided into three groups according to the areas where they lived, which included Seoul (n = 230), provincial cities (n = 273) and rural areas (n = 202). The subjects were asked to fill out questionnaires which were categorized to determine various factors related to food ecology, life styles, and health related symptoms. The average age of the study subjects was 11.5 years. The results showed that the average height (p < 0.01), weight (p < 0.01) and body mass index (BMIs)(p < 0.01) of the rural group were significantly lower than those of the Seoul and provincial city groups. A significantly higher proportion (10.4%) of the rural group was from disfunctional families, including single parent families, than those of the Seoul (1.7%) or provincial city (4.4%) groups. However, a larger number of children from Seoul ate alone, did not enjoy their meals, and hardly talked to each other during breakfast time, compared to those from the provincial city or rural areas. Also, the proportion (33.0%) of 'good' in balance of meal was the lowest (33.0%) in Seoul of the three areas (p < 0.01). Most of the children answered that they liked having breakfast and dinner with the whole family. In conclusion, the food ecology of elementary children differed according to the regions in which they resided. Although children from Seoul had higher BMIs, their nutritional intake was not satisfactory, and their undesirable food ecology could be a contributing factor.
Atmosphere ; Body Mass Index ; Breakfast ; Child* ; Ecology* ; Female ; Humans ; Korea ; Life Style ; Meals ; Seoul ; Single-Parent Family ; Surveys and Questionnaires

BACKGROUND/AIMS: We evaluated whether manometric subtype is associated with treatment outcome in patients with achalasia treated by peroral endoscopic myotomy (POEM). METHODS: High-resolution manometry data and Eckardt scores were collected from 83 cases at two tertiary referral centers where POEM is performed. Manometric tracings were classified according to the three Chicago subtypes. RESULTS: Among the 83 cases, 48 type I, 24 type II, and 11 type III achalasia cases were identified. No difference was found in pre-POEM Eckardt score, basal lower esophageal sphincter (LES) pressure, or integrated relaxation pressure (IRP) among the type I, type II, and type III groups. All three patient groups showed a significant improvement in post-POEM Eckardt score (6.1±2.1 to 1.5±1.5, p=0.001; 6.8±2.2 to 1.2±0.9, p=0.001; 6.6±2.0 to 1.6±1.4, p=0.011), LES pressure (26.1±13.8 to 15.4±6.8, p=0.018; 32.3±19.0 to 19.2±10.4, p=0.003; 36.8±19.2 to 17.5±9.7, p=0.041), and 4s IRP (21.5±11.7 to 12.0±8.7, p=0.007; 24.5±14.8 to 12.0±7.6, p=0.002; 24.0±15.7 to 11.8±7.1, p=0.019) at a median follow-up of 16 months. CONCLUSIONS: POEM resulted in a good clinical outcome for all manometric subtypes.
Esophageal Achalasia* ; Esophageal Sphincter, Lower ; Follow-Up Studies ; Humans ; Manometry ; Relaxation ; Tertiary Care Centers ; Treatment Outcome

Bezoars are accumulations of foreign materials and foods in the gastrointestinal tract and can be the cause of small bowel obstruction. A bezoar usually begins as a gastric phytobezoar that migrates to the small bowel in patients who have undergone gastric surgery and have delayed gastric emptying. We report a case of diagnosed small bowel obstruction due to the presence of a persimmon phytobezoar (diospyrobezoar) in a patient with a history of gastric surgery. Abdomen-pelvis computed tomography demonstrated the presence of an air-containing localized lesion (5x3.5 cm), a suspicious bezoar in the jejunum. The gastroduodendoscopy failed to reach to the lesion but diospyrobezoars were found in the proximal jejunum at 120 cm from the upper incisors using a colonoscope inserted using the oral approach. Most of the bezoars were fragmented by a tripod and were removed with a snare. The patient was discharged after symptomatic improvement without surgery. We report this case with a review of the relevant literature.
Bezoars ; Colonoscopes ; Colonoscopy ; Diospyros ; Gastric Emptying ; Gastrointestinal Tract ; Humans ; Incisor ; Intestinal Obstruction ; Jejunum ; SNARE Proteins